**Current Plan Text: > The United States Federal Government should substantially increase
its public health assistance to Sub-Saharan Africa by fully funding
the creation of disease surveillance laboratories in Sub-Saharan
Africa under the authority of the Department of Defense.
OBSERVATION ONE: INHERENCY
FRAGMENTATION PLAGUES THE CURRENT AFRICAN DISEASE SURVEILLANCE—THIS CRUSHES THE ABILITY TO DETECT AND MONITOR DISEASES EFFECTIVELY.
Jonathan R. Davis and Joshua Lederberg (Editors), Forum on Emerging Infections, Board on Global Health, Institute of Medicine (Authoring organization), 2001, “Emerging Infectious Diseases from the Global to the Local Perspective”, p. 52-53, http://books.nap.edu/openbook.php?record_id=10084
As a region, Africa is characterized by the greatest infectious disease burden and, overall, the weakest public health infrastructure among all regions in the world. Frequently, vertically oriented disease surveillance programs at the national level and above in Africa often result in too much paperwork, too many different instructions, different terminologies, too many administrators, and conflicting priorities. Streamlined communications, strengthened public health surveillance, the use of standard case definitions, criteria for minimum data requirements, and emphasis on feedback through integrated forms, as well as research and training opportunities, are among the important tools available to improve the situation. Yet, efforts to establish fully more effective public health infrastructures may take a period of years to decades.
The aim in Africa is to identify a group of priority diseases categorized as epidemic-prone diseases, diseases targeted for eradication or elimination, and other diseases of public health importance. The challenge will be to integrate surveillance and epidemic preparedness and response activities for these priority diseases, especially when there are weakened ministries of health. Bilateral and multilateral agreements, as well as partnerships with nongovernmental organizations and commercial interests, are among the means being explored to strengthen disease surveillance and response activities, to transfer epidemiological and microbiological skills, and to facilitate timely recognition of these disease outbreaks and their control. Among the promising roles provided by global disease surveillance is the integration of new technology tools in resource-poor environments, such as in sub-Saharan Africa, for the development of an early-warning system based on remotely sensed (satellite) data for Rift Valley fever surveillance.
ADDITIONALLY, THE AFRICAN SURVEILLANCE SYSTEM LACKS TRAINED PERSONNEL AND LAB FACILITIES.
With avian flu spreading around the world at a frightening rate, scientists are welcoming an international proposal for state-of-the-art labs to monitor emerging diseases in developing countries. But they add that the bird-flu crisis has exposed glaring deficiencies that demand a radical rethink of the world's veterinary and disease-surveillance systems.
Avian flu is now endemic across large parts of Asia, and in the past few weeks has exploded across Europe and into Africa. "H5N1 has focused the spotlight of the world on disease surveillance, and it's showing up all the pimples and warts," says Bill Davenhall, who develops health mapping schemes for countries and is head of health at ESRI, a geographic information systems company in Redlands, California.
Developing countries, in particular, lack decent human-disease surveillance, and animal monitoring is often virtually nonexistent, with few basic laboratory and epidemiological resources available. "On the ground in Indonesia, there is no systematic programme at all," says Peter Roeder, a field consultant with the United Nations' Food and Agriculture Organization (FAO). "It's just a bloody mess."
It is a problem that the developed world cannot ignore, because a disease that emerges in Bangkok or Jakarta could ultimately trigger a global disaster. So researchers at the US Department of Defense have suggested setting up a network of high-tech labs in developing countries to monitor cases of infectious disease (see page 25). The labs would be modelled on the US network of infectious-disease labs, such as the naval research unit NAMRU-2 in Jakarta. But they would be funded by the international community
Such a network could vastly speed up and improve the diagnosis of viruses such as H5N1 when outbreaks occur, says Roeder. He points out that misdiagnosis of H5N1 as Newcastle disease in recent outbreaks in Nigeria and India led to long delays in control measures.
Mark Savey, an epidemiologist who heads animal health at France's food-safety agency, also welcomes the proposal, but cautions against the "mirage of technology" in surveillance. "You don't need satellites, PCR and geographic information systems to fight outbreaks," he says. The labs' top priority should be building large teams of local staff, who are familiar with the region and its practices, he argues. "If you do not have that, then surveillance will stay in the Middle Ages."
Savey recalls his trip to Russia last summer as part of a European team investigating outbreaks of avian flu. "You have a paper Michelin map; you have people who speak the language; you put red circles on outbreaks; and you use a pen and paper to compare them with things like the dates of market openings, and with how outbreaks line up with railways." Such local knowledge is crucial to interpreting data, he says. "If you don't know what the Trans-Siberian Express is like, with people cooped up for days, exchanging chickens and eggs at every stop, you would never guess that it was the Trans-Siberian that mainly spread avian flu across Russia."
Roeder agrees that the focus must be local. "No amount of setting international guidelines and publishing global action plans is going to help when you have an organization within the country that doesn't know what to do," he says
ADVANTAGE ONE: DISEASES
THE DANGER OF NEW AND REMERGING DISEASES IS GROWING—THEY QUICKLY SPREAD ACROSS BORDERS MAKING THEM DIFFICULT TO CONTAIN.
US Government Accountability Office, 9-04, “EMERGING INFECTIOUS DISEASES: Review of State and Federal Disease Surveillance Efforts” <http://purl.access.gpo.gov/GPO/LPS55456> [Sigrist]
Infectious diseases account for millions of deaths every year. Although the
great majority of these deaths occur in developing countries, infectious
diseases are not confined by international borders and therefore present a
substantial threat to populations in all parts of the world, including the
United States. In recent years, the threat posed by infectious diseases has
grown. New diseases, unknown in the United States just a decade ago,
such as West Nile virus and severe acute respiratory syndrome (SARS),
have emerged, and known infectious diseases once considered in decline
have reappeared with increased frequency. Furthermore, there is always
the potential for an infectious disease to develop into a widespread
outbreak—which could have significant consequences. The Centers for
Disease Control and Prevention (CDC) estimates that if an influenza
pandemic1 were to occur in the United States, it could cause an estimated
314,000 to 734,000 hospitalizations and 89,000 to 207,000 deaths, with
associated costs ranging from $71 to $167 billion.2 In addition to naturally
occurring infectious disease outbreaks, there is also the threat posed by
the deployment of infectious disease pathogens3 as weapons of war or
instruments of terror.
SPECIFICALLY, SUB SAHARAN AFRICA HAS BECOME AN “IDEAL INCUBATOR” FOR THESE PATHOGENS TO GROW STRONGER.
Some of the viruses are notorious, such as Ebola and HIV. Others have less familiar names: Marburg and Lassa fever. But they all have emerged in recent decades from sub-Saharan Africa, perplexing scientists and, in the case of HIV, killing millions. Africa is recognized as an ideal incubator for new pathogens: It has rapidly growing human populations and high biodiversity, along with widespread poverty, poor medical care and, in many countries, armed conflict that forces civilians to flee far from their homes. "For every virus that we know about, there are hundreds that we don't know anything about," said Dr. Dan Bausch, a professor at the Tulane School of Public Health and Tropical Medicine who studies Marburg, Ebola and other emerging diseases in Africa. "Most of them, we probably don't even know that they're out there." Scientists remain especially baffled by Marburg. Since 1967, the Marburg virus and its equally lethal cousin, Ebola, have killed more than 1,600 people. The latest Marburg outbreak has killed at least 277 people in Angola, hundreds of miles from where it last emerged four years ago, in the Democratic Republic of Congo. "To be honest with you, I have no indication what the source is," said Dr. Pierre Formenty, the World Health Organization's senior Marburg expert, speaking from the epicenter of the outbreak, in Uige, Angola. "That was not our first priority. Now we are working on it."
SUBPOINT A: SUPERDISEASES
SEVERAL FACTORS INFLUENCE THE GROWTH AND SPREAD OF PATHOGENS- POPULATION GROWTH, CLIMATE CHANGE, DRUG RESISTANCE, LIVESTOCK HANDLING—ARE ONLY A FEW OF THE THINGS THAT CONTRIBUTE TO MUTATIONS OF DISEASES.
Researchers say West Nile may be just one example of an infectious disease whose incidence and geographic range have expanded because of human activities affecting the mosquitoes, birds, rodents and other animals that help spread the infection. Since the mid-1970's -- a time when it was widely assumed that most infectious diseases had been conquered or at least controlled -- a troubling array of previously unknown diseases has emerged, including Lyme disease, AIDS, mad cow disease, the Ebola virus, Legionnaires' disease and a host of others. In addition, old diseases like yellow fever, malaria and dengue fever have reappeared in their former haunts and spread to new areas. Some microbes, like the ones that cause tuberculosis, malaria and food poisoning, have become dangerously drug resistant. In a 2000 report, the World Health Organization identified a half-dozen factors that could affect the distribution and emergence of infectious diseases. The factors include ecological changes like those from global warming and changes in land use; human factors like population growth, migration, war, sexual behavior, intravenous drug use and overcrowding; international travel and commerce; technological and industrial factors like food processing, livestock handling and organ transplants; microbial changes like the development of antibiotic resistance; and breakdowns in public health measures like sanitation, vaccination and insect control.
THESE MUTATIONS ARE GROWING THREATENING AS DISEASES ARE BECOMING INCREASINGLY DRUG RESISTANCE.
On another front, resistance to inexpensive and effective
antimicrobial drugs has emerged and spread at an alarming
rate, raising the prospect that many common diseases could
become prohibitively expensive or impossible to treat.27 The
bacterial infections that contribute most to human disease
are also those in which emerging resistance is of most
concern: diarrhoeal diseases such as dysentery, respiratory
tract infections, including pneumococcal pneumonia and
multidrug-resistant tuberculosis, sexually transmitted
infections such as gonorrhoea, and a host of hospitalacquired
infections that are notoriously difficult and
expensive to treat. Among the major infectious diseases, the
development of resistance to drugs commonly used to treat
malaria is of particular concern, as is the emerging resistance
to anti-HIV drugs. Most alarming of all are microbes such as
Staphylococcus aureus and Salmonella typhi that have
accumulated resistance genes to virtually all currently
available drugs and have the potential to cause untreatable
infections, thus raising the spectre of a post-antibiotic era.
Even if the pharmaceutical industry were to step up efforts
to develop new drugs immediately, current trends suggest
that some diseases may have very few and, in some cases, no
effective therapies within the next 10 years.27 Moreover, if
current trends continue, many important medical and
surgical procedures, including cancer chemotherapy, bone
marrow and organ transplantation, and hip and other joint
replacements, could no longer be undertaken out of fear that
the associated compromise of immune function might place
patients at risk of acquiring a difficult to treat and ultimately
fatal infection. Opportunistic infections in AIDS patients
would likewise become an especially difficult challenge.
EVENTUALLY THESE MUTATIONS WILL GET OUT OF CONTROL—CULMINATING IN PLANETARY EXTINCTION.
South China Morning Post 96
((Hong Kong) January 4, 1996 SECTION: Pg. 15 HEADLINE: Leading the way to a cure for AIDS BYLINE: Kavita Daswani meets a scientist working on a super vaccine to fight AIDS and more deadly viruses yet to come, l/n)
Despite the importance of the discovery of the "facilitating" cell, it is not what Dr Ben-Abraham wants to talk about. There is a much more pressing medical crisis at hand - one he believes the world must be alerted to: the possibility of a virus deadlier than HIV. If this makes Dr Ben-Abraham sound like a prophet of doom, then he makes no apology for it. AIDS, the Ebola outbreak which killed more than 100 people in Africa last year, the flu epidemic that has now affected 200,000 in the former Soviet Union - they are all, according to Dr Ben-Abraham, the "tip of the iceberg". Two decades of intensive study and research in the field of virology have convinced him of one thing: in place of natural and man-made disasters or nuclear warfare, humanity could face extinction because of a single virus, deadlier than HIV. "An airborne virus is a lively, complex and dangerous organism," he said. "It can come from a rare animal or from anywhere and can mutate constantly. If there is no cure, it affects one person and then there is a chain reaction and it is unstoppable. It is a tragedy waiting to happen." That may sound like a far-fetched plot for a Hollywood film, but Dr Ben -Abraham said history has already proven his theory. Fifteen years ago, few could have predicted the impact of AIDS on the world. Ebola has had sporadic outbreaks over the past 20 years and the only way the deadly virus - which turns internal organs into liquid - could be contained was because it was killed before it had a chance to spread. Imagine, he says, if it was closer to home: an outbreak of that scale in London, New York or Hong Kong. It could happen anytime in the next 20 years - theoretically, it could happen tomorrow. The shock of the AIDS epidemic has prompted virus experts to admit "that something new is indeed happening and that the threat of a deadly viral outbreak is imminent", said Joshua Lederberg of the Rockefeller University in New York, at a recent conference. He added that the problem was "very serious and is getting worse". Dr Ben-Abraham said: "Nature isn't benign. The survival of the human species is not a preordained evolutionary programme. Abundant sources of genetic variation exist for viruses to learn how to mutate and evade the immune system." He cites the 1968 Hong Kong flu outbreak as an example of how viruses have outsmarted human intelligence. And as new "mega-cities" are being developed in the Third World and rainforests are destroyed, disease-carrying animals and insects are forced into areas of human habitation. "This raises the very real possibility that lethal, mysterious viruses would, for the first time, infect humanity at a large scale and imperil the survival of the human race," he said.
SUB POINT B IS RE-REMERGING DISEASES- THE FLU
[MUTATION OF THE AVIAN FLU IS INEVITABLE—IT IS ONLY A MATTER OF TIME UNTIL IT IS AIRBORNE.
Satish Chandra, Deputy National Security Advisor of India – Center for Strategic Decision Research, 2004
[Global Security: A broader Concept for the 21st Century, 5/7, http://www.csdr.org/2004book /chandra.htm]
If the possibility of the collapse of the thermohaline circulation system is alarming, the possibility of a human-to-human transmittable bird flu pandemic is a nightmare. What makes it so frightening is the fact that it could happen at any time and that we are ill prepared to face it. At current mortality rates, it could result in the sudden death of 15 to 20 percent of mankind. The most severe health crisis in recent years in terms of numbers of deaths was the 1918–1919 influenza epidemic, which in the space of one year caused an estimated 40 million deaths worldwide. Begun in Kansas in March 1918, the epidemic spread to Europe and then to India, Australia, and New Zealand. The virulence and mortality rate of the first wave of the disease, in the spring of 1918, was only slightly above normal levels but the second wave, which began in the fall of 1918, was extraordinarily deadly, with mortality rates of 5 to 20 percent above normal levels. It is believed that the fall strain of the virus came about through genetic mutation and that the genetic structure of the virus was a form of a swine and avian influenza strain. Since 1918, the world has seen several influenza outbreaks, most notably the 1957 Asian flu outbreak and the 1968 Hong Kong flu outbreak, each of which killed a million people. While WHO now has an Influenza Surveillance Program in place as well as an Influenza Pandemic Preparedness Plan, we still need to examine the possibility of the highly pathogenic H5N1 bird flu becoming transmittable from human to human, the outcome of such a situation, and what must be done to address the possibility. Since the end of 2003, outbreaks of the highly pathogenic H5N1 strain of avian influenza, or bird flu, have occurred in eight Asian countries, resulting in the loss of 100 million poultry birds. The implications for human health are worrisome because of the extreme pathogenic nature of this virus—it has the capability to infect humans and cause severe illness, with mortality rates of 60 to 70 percent. It has already infected humans three times in the recent past: In 1997 and 2003 in Hong Kong and in 2004 in Vietnam and Thailand. So far the disease has been transmitted only to humans who came in contact with dead or diseased poultry—it has not yet mutated to being capable of human-to-human transmission. The Likelihood of a Pandemic Since the H5N1 strain has not been eliminated from its avian hosts, it is obviously endemic. The risk, therefore, that the virus could take on a new form that would make it capable of human-to- human transmission is considerable, especially because mass vaccinations of chickens, aimed at mitigating the disaster facing poultry farmers, has allowed the virus to continue to circulate among the vaccinated birds. It can thus linger indefinitely in poultry, making the gene mutation required to make it transmittable from human to human an even greater possibility. It could be said that there are three prerequisites for the start of a pandemic: 1) a new virus must emerge against which the general population has little or no immunity; 2) the new virus must be able to replicate in humans and cause disease; and 3) the new virus must be efficiently transmitted from one human to another. Dr. Anarji Asamoa Baah, Assistant Director General, Communicable Diseases, WHO, asserts that, regarding H5N1, the first two prerequisites have already been met, and it is known that the virus can become more transmittable via two mechanisms, “adaptive mutation” and “genetic re-assortment.” Dr. Baah has further contended that re-assortment of H5N1 with a human influenza virus can take place in humans without prior adaptation in other species such as swine. It is clear, therefore, that 1) the H5N1 virus will continue to circulate for a very long time in poultry birds; 2) the threat to public health will be there as long as the virus continues to circulate in poultry birds; 3) should the virus become transmittable from human to human, the consequences for human health worldwide, in the words of Dr. Baah, “could be devastating;” and 4) the world needs to be prepared to respond to the next influenza outbreak. During an Influenza Pandemic Preparedness meeting in Geneva in March 2004, the head of the World Health Organization warned, “We know another pandemic is inevitable. It is coming…we also know that we are unlikely to have enough drugs, vaccines, healthcare workers, and hospital capacity to cope in an ideal way.” On the basis of an epidemiological model project, WHO scientists predict that an influenza pandemic will result in 57 million to 132 million outpatient hospital visits, 1 million to 2.3 million admissions, and between 280,000 and 650,000 deaths in less than two years. The impact on poor nations would be much greater. But I submit that these projections are gross underestimates given the fact that the 1918–1919 influenza epidemic, with mortality rates of a maximum of 20 percent above normal level, caused as many as 40 million deaths. With mortality rates in excess of 60 percent, the H5N1 virus is bound to be much more deadly, particularly because in today’s world of air connectivity, the spread of H5N1 would be much more rapid than that of the 1918 influenza epidemic. Indeed, the death toll could run into hundreds of millions.
AVIAN BIRD FLU WILL KILL BILLIONS.
Satish Chandra, Center for Strategic Decision Research, 2004
[Global Security: A broader Concept for the 21st Century, May 7th http://www.csdr.org/2004book /chandra.htm]
This scenario, as frightening as it is, pales in comparison with what could overtake us by 2007 if the highly pathogenic form of bird flu “H5N1” becomes transmittable human to human; all it would take for this to happen is a simple gene shift in the bird flu virus, which could happen any day. In a globalized world linked by rapid air travel, the disease would spread like a raging forest fire. If it did, it would overwhelm our public health system, cripple our economies, and wipe out a billion people within the space of a few months—a 60 percent mortality rate is estimated.
SURVEILLANCE IS CRITICAL TO MONITOR ANIMAL TRANSFERRED PATHOGENS.
Paul Rincon, BBC News science reporter, 2/20/06, ("'Faster emergence' for diseases", http://news.bbc.co.uk/2/hi/science/nature/4732924.stm)
New infectious diseases are now emerging at an exceptional rate, scientists have told a leading conference in St Louis, US. Humans are accumulating new pathogens at a rate of one per year, they said.
This meant that agencies and governments would have to work harder than ever before to keep on top of the threat, one expert told the BBC. Most of these new infectious diseases, such as avian influenza and HIV/Aids, are coming from other animals. "This accumulation of new pathogens has been going on for millennia - this is how we acquired TB, malaria, smallpox," said Professor Mark Woolhouse, an epidemiologist at the University Of Edinburgh, UK. "But at the moment, this accumulation does seem to be happening very fast. "So it seems there is something special about modern times - these are good times for pathogens to be invading the human population." Professor Woolhouse has catalogued more than 1,400 different agents of disease in humans; and every year, scientists are discovering one or two new ones.
Some may have been around for a long time and have only just come to light. Others that have emerged recently are entirely new, such as HIV; the virus that causes Sars, and the agent of vCJD. The difference today, say researchers, is the way humans are interacting with other animals in their environment. Changes in land use through, for example, deforestation can bring humans into contact with new pathogens; and, likewise, agricultural changes, such as the use of exotic livestock. Other important drivers include global travel, global trade and hospitalisation. The fast rate at which pathogens are appearing means public health experts will need to work harder than ever to control the spread of emerging disease threats. "The sort of image I want to get away from is the famous statement from the 1960s when the US Surgeon General said, 'diseases were beat'," Professor Woolhouse told the BBC News website. "Pathogens are evolving ways to combat our control methods. The picture is changing and looks as if it will continue to. We're going to have to run as fast as we can to stay in the same place." He added: "We need surveillance. Surveillance in most parts of the world for infectious disease is really quite poor - particularly surveillance for infectious diseases in animals such as vermin like rats." Experts were speaking on the subject at the American Association for the Advancement of Science (AAAS) annual meeting in the Missouri city of St Louis.
ADVANTAGE TWO: BIOTERRORISM
RISK OF A BIOTERROR ATTACK IS HIGH WITH THE WIDESPREAD OFMATERIALS, INFORMATION, AND RECRUITMENT IN ABUNDANCE.
Unfortunately, both the risk of a bioterror attack and the potential destruction such an attack could cause are significant—and rising.
In assessing the risk of a given type of attack, there are three ingredients to measure: the availability of the relevant materials (from small arms to "loose nukes"); the availability of know-how to overcome the obstacles to using those materials to effect an attack; and the existence of actors with the motive to use them. In the case of bioterrorism, all three ingredients are very much present.
First, there is no shortage of supply. The biological materials for potentially deadly attacks are tremendously widespread. By one estimate, there are more than 10,000 facilities worldwide that legally and legitimately possess materials that, if weaponized, could cause enormous loss of life, morbidity, and erosion of health. Many of these facilities are agricultural and commercial, not engaged in high-tech bioengineering or advanced processes that could reasonably be expected to come with detailed tracking of materials and effective security arrangements.
Second, there is no shortage of know-how. One of the great advantages of the biological and health industry is its widening base of scientists worldwide—an advantage that has an obvious downside, in the existence [in] of a large number of individuals whose knowledge can be tapped for nefarious purposes. Moreover, the technological know-how and materials for weaponizing several biological agents is increasingly available, even to individuals. In preparing background materials for the High-Level Panel, we were warned by some of the world's leading scientists that it would be only a matter of years before the tools required for weaponization were available through the Web. As we completed our work, some of these same scientists alerted us to the fact that they had been mistaken: materials are already available on the Web, often for as little as $50,000.
Third, there is no shortage of groups with motive—at least, as far as we know. Certainly, senior al-Qaeda officials have stated publicly and in captured correspondence between themselves their interest in obtaining nuclear, biological, and chemical materials for use in large-scale terrorist attacks. But the history of modern terrorism suggests that we should be every bit as concerned by groups we don't yet know about. Given the widespread availability and relatively easy accessibility of materials, and the accessibility of equipment and know-how to weaponize them, even fairly unsophisticated groups pose a threat. Indeed, as the science and the technology develops, we face the prospect that eventually small groups and even individuals will possess the technological ability to threaten even powerful states.
A BIOTERRORIST ATTACK WOULD RESULT IN EXTINCTION AS THE ATTACK CAN’T BE CONTAINED AND WILL SPREAD QUICKLY.
Richard Ochs, president of CWWG (Chemical Weapons Working Group), 2002 "biological weapons must be abolished immediately" <http://www.freefromterror.net/other_articles/abolish.html>
Of all the weapons of mass destruction, the genetically engineered biological weapons, many without a known cure or vaccine, are an extreme danger to the continued survival of life on earth. Any perceived military value or deterrence pales in comparison to the great risk these weapons pose just sitting in vials in laboratories.
While a "nuclear winter," resulting from a massive exchange of nuclear weapons, could also kill off most of life on earth and severely compromise the health of future generations, they are easier to control. Biological weapons, on the other hand, can get out of control very easily, as the recent anthrax attacks has demonstrated. There is no way to guarantee the security of these doomsday weapons because very tiny amounts can be stolen or accidentally released and then grow or be grown to horrendous proportions. The Black Death of the Middle Ages would be small in comparison to the potential damage bioweapons could cause.
Abolition of chemical weapons is less of a priority because, while they can also kill millions of people outright, their persistence in the environment would be less than nuclear or biological agents or more localized. Hence, chemical weapons would have a lesser effect on future generations of innocent people and the natural environment. Like the Holocaust, once a localized chemical extermination is over, it is over. With nuclear and biological weapons, the killing will probably never end. Radioactive elements last tens of thousands of years and will keep causing cancers virtually forever.
Potentially worse than that, bio-engineered agents by the hundreds with no known cure could wreck even greater calamity on the human race than could persistent radiation. AIDS and ebola viruses are just a small example of recently emerging plagues with no known cure or vaccine. Can we imagine hundreds of such plagues? HUMAN EXTINCTION IS NOW POSSIBLE.
LUCKILY, DISEASE SURVEILLANCE IS AN OPPORTUNITY TO TAP INTO THE PUBLIC HEALTH SYSTEM AS AN INTELLIGENCE RESOURCE IN ORDER TO PREVENT AND RAPIDLY RESPOND TO A POTENTIAL ATTACK.
PRNewswire, 8-4,-2005, Nexus (C-5)
"Better medical surveillance tools and stronger links between law enforcement and national health authorities are needed to help protect the world against attacks from terrorists using chemical or biological weapons," emergency preparedness specialist Michael J. Hopmeier told a recent conference on integrating intelligence, policing and health, co-hosted by the Public Health Agency of Canada.
"The public health system presents an enormous untapped resource for intelligence gathering and the protection of national security," said Hopmeier, President of Unconventional Concepts Inc., a Mary Esther, Florida- based engineering and scientific consulting firm specializing in crisis management and integrated federal/civilian disaster response.
"Beyond the roles in prevention and protection played by the public health sector, and their obvious implications for national security, there is also an enormous infrastructure for early warning detection of terrorist threats," Hopmeier said. "For that reason, public health agencies can contribute to both intelligence collection and national security
THUS WE OFFER THE FOLLOWING PLAN:
The United States Federal Government should substantially increase its public health assistance to Sub-Saharan Africa by fully funding the creation of disease surveillance laboratories in Sub-Saharan Africa under the authority of the Department of Defense.
OBSERVATION TWO: SOLVENCY
EMPIRICALLY, THE DOD HAS BEEN EFFECTIVE AT PREVENTING AND TREATING DISEASE OUTBREAKS IN AFRICA.
Patrick W. Kelley, M.D., Dr. P.H., Colonel and Director, Division of Preventive Medicine Walter Reed Army Institute of Research, Institute of Medicine (Authoring organization), 2001, “Emerging Infectious Diseases from the Global to the Local Perspective”, p. 57, http://books.nap.edu/openbook.php?record_id=10084
An example of recent DOD involvement in Africa was the outbreak of Rift Valley fever in 1997–1998 in East Africa. Approximately 80,000 people ultimately contracted Rift Valley fever, resulting in hundreds of deaths. In addition to the direct toll on the human population, there was a tremendous toll on the animal population in this pastoral economy. Using its laboratory in Kenya, DOD was able to quickly assist with the initial epidemiological and entomological investigations. At the time that the outbreak surfaced Kenya had no laboratory capacity for the diagnosis of Rift Valley fever. Specimens had to be sent to either South Africa or CDC to make the diagnosis. Using resources at its laboratory in Cairo, DOD was able to quickly transfer technology for rapid diagnosis to Kenya so that the outbreak could be defined rapidly and locally. Experts in remote sensing also collected data to establish indicators that are evident at least 3 or 4 months before outbreaks. In the future this will enable the government to initiate immunizations for animals and thus prevent the amplification of the virus and its transmission to humans. DOD also provided access to the Rift Valley fever vaccine for at-risk laboratory workers in Kenya.
DOD LABORATORIES ARE CAPABLE OF STREAMLINING THE AFRICAN SURVEILLANCE SYSTEM, AND OFFER THE BEST TECHNOLOGY AND PERSONNEL TRAINING.
Patrick W. Kelley, M.D., Dr. P.H., Colonel and Director, Division of Preventive Medicine Walter Reed Army Institute of Research, Institute of Medicine (Authoring organization), 2001, “Emerging Infectious Diseases from the Global to the Local Perspective”, p. 56, http://books.nap.edu/openbook.php?record_id=10084
A major asset is the DOD network of overseas laboratories in Egypt, Kenya, Thailand, Indonesia, and Peru. These are medical research and development laboratories that in some cases were established more than 50 years ago and that exist primarily for the purpose of product development. For example, the key studies conducted for the licensure of the hepatitis A and the Japanese encephalitis vaccines were done at these laboratories.
These laboratories have, in some instances, a biosafety level 3 capability. The laboratory in Cairo, Egypt, can if necessary, adapt to a biosafety level 4 capability. Although located in 5 countries, these laboratories have active research programs in about 31 countries; they have established extensive networks in their regions and have formal relationships with many ministries of health and the WHO.
The laboratories have tremendous depth. In almost every case they have expertise in virology, bacteriology, parasitology, other aspects of microbiology, veterinary medicine, and epidemiology. Although their primary purpose was to support product development, increasingly they are becoming involved with surveillance. In all, about 700 people work at these laboratories and are backed up by more than 800 more DOD scientists working on issues related to emerging infections.
The laboratories have additional assets: they are networked with state-of-the-art communications technologies and possess cutting-edge field diagnostic reagents that are field oriented, rapid, and invaluable in the response to emerging infectious diseases. In addition, the laboratories have access to special drugs and vaccines that might be of critical importance in regions with outbreaks of unusual pathogens.
FINALLY, THE US HAS TO ACT—ONLY THE US CAN ENSURE GLOBAL DISEASE COOPERATION.
David P. Fidler, professor of law, University of Indiana, 3/6/05, “Germs, Norms, and Power: Global Health’s Political Revolution”, http://www2-test.warwick.ac.uk/fac/soc/law/elj/lgd/2004_l/fidler/
Dramatic change marks the history of health as an issue in international relations. Health’s emergence as a foreign policy concern in the mid-19th century, when European nations began to confront cooperatively the cholera menace, represents one such dramatic transition in how health was conceptualised and approached internationally. Subsequent treaties and international health organisations also transformed health as a foreign policy concern. Technological developments, especially antibiotics and vaccines, also produced change for public health globally.
These examples of changes in international health reveal and obscure. They reveal that health has long been a foreign policy issue. Given this history, ‘health as foreign policy’ is not a novel idea. The examples obscure that health has historically been relegated to the foreign policy fringe of technical assistance and humanitarianism. The lack of interest in health by those studying foreign policy and international relations compounded the neglect (Lee, K and Zwi, A, 2003, p 13; Kickbusch, I, 2003, p 192). Given this situation, ‘health as foreign policy’ was not an important diplomatic activity.
Dramatic change has, however, again visited health as an issue in international relations. In the past decade, health emerged from obscurity and neglect to affect many foreign and international policy agendas. Health now features prominently in debates concerning national and homeland security, international trade, economic development, globalisation, human rights, and global governance. The attention health has received in the past ten years in national and international politics is unprecedented. Kickbusch (2003, pp 192-93) captured this change:
The protection of health is no longer seen as primarily a humanitarian and technical issue relegated to a specialised UN agency, but more fully considered in relation to the economic, political, and security consequences for the complex post-Cold War system of interdependence. This has led to new policy and funding initiatives at many levels of governance and a new political space within which global health action is conducted.
Health as a global issue has undergone a political revolution in the last decade. Health’s emergence into the ‘high politics’ of international relations is a complicated and controversial development. Global health’s political revolution means that traditional approaches to, and attitudes about, public health have been ripped from their moorings and set afloat on a volatile sea. This article examines global health’s political revolution by analyzing its components and how they relate to each other in an attempt to understand the meaning of this revolution for global health’s future.
Revolutions constitute radical changes within existing political systems, and they typically involve three elements: (1) a crisis with the status quo; (2) a challenge from normative ideas different from those operative in the existing system; and (3) the application of material power to install the new ideas as the basis for future action. The article explores each of these elements in connection with global health’s transformation as an issue in international relations.
The crisis comes from threats posed by infectious diseases (germs). The mounting microbial menace has stimulated ferment among policy responses that seek to supercede existing strategies and alter how state and non-state actors address pathogenic threats (norms). The competing ideas require material resources and capabilities to contain and mitigate the microbial challenge to health (power).
How germs, norms, and power converge shapes the nature of global health’s political revolution. I argue that the political revolution remains enigmatic, and the enigma raises questions about the revolution’s impact and sustainability. Global health’s political revolution serves as a window on the future of not only the protection of health but also 21st century world politics.
OBSERVATION ONE: INHERENCY
FRAGMENTATION PLAGUES THE CURRENT AFRICAN DISEASE SURVEILLANCE—THIS CRUSHES THE ABILITY TO DETECT AND MONITOR DISEASES EFFECTIVELY.
Jonathan R. Davis and Joshua Lederberg (Editors), Forum on Emerging Infections, Board on Global Health, Institute of Medicine (Authoring organization), 2001, “Emerging Infectious Diseases from the Global to the Local Perspective”, p. 52-53, http://books.nap.edu/openbook.php?record_id=10084
As a region, Africa is characterized by the greatest infectious disease burden and, overall, the weakest public health infrastructure among all regions in the world. Frequently, vertically oriented disease surveillance programs at the national level and above in Africa often result in too much paperwork, too many different instructions, different terminologies, too many administrators, and conflicting priorities. Streamlined communications, strengthened public health surveillance, the use of standard case definitions, criteria for minimum data requirements, and emphasis on feedback through integrated forms, as well as research and training opportunities, are among the important tools available to improve the situation. Yet, efforts to establish fully more effective public health infrastructures may take a period of years to decades.
The aim in Africa is to identify a group of priority diseases categorized as epidemic-prone diseases, diseases targeted for eradication or elimination, and other diseases of public health importance. The challenge will be to integrate surveillance and epidemic preparedness and response activities for these priority diseases, especially when there are weakened ministries of health. Bilateral and multilateral agreements, as well as partnerships with nongovernmental organizations and commercial interests, are among the means being explored to strengthen disease surveillance and response activities, to transfer epidemiological and microbiological skills, and to facilitate timely recognition of these disease outbreaks and their control. Among the promising roles provided by global disease surveillance is the integration of new technology tools in resource-poor environments, such as in sub-Saharan Africa, for the development of an early-warning system based on remotely sensed (satellite) data for Rift Valley fever surveillance.
ADDITIONALLY, THE AFRICAN SURVEILLANCE SYSTEM LACKS TRAINED PERSONNEL AND LAB FACILITIES.
Declan Butler, senior reporter at Nature, 3-2-06, Nature 440 pp. 6-7, “Disease Surveillance needs a revolution” <http://www.nature.com/nature/journal/v440/n7080/full/440006a.html>
With avian flu spreading around the world at a frightening rate, scientists are welcoming an international proposal for state-of-the-art labs to monitor emerging diseases in developing countries. But they add that the bird-flu crisis has exposed glaring deficiencies that demand a radical rethink of the world's veterinary and disease-surveillance systems.
Avian flu is now endemic across large parts of Asia, and in the past few weeks has exploded across Europe and into Africa. "H5N1 has focused the spotlight of the world on disease surveillance, and it's showing up all the pimples and warts," says Bill Davenhall, who develops health mapping schemes for countries and is head of health at ESRI, a geographic information systems company in Redlands, California.
Developing countries, in particular, lack decent human-disease surveillance, and animal monitoring is often virtually nonexistent, with few basic laboratory and epidemiological resources available. "On the ground in Indonesia, there is no systematic programme at all," says Peter Roeder, a field consultant with the United Nations' Food and Agriculture Organization (FAO). "It's just a bloody mess."
It is a problem that the developed world cannot ignore, because a disease that emerges in Bangkok or Jakarta could ultimately trigger a global disaster. So researchers at the US Department of Defense have suggested setting up a network of high-tech labs in developing countries to monitor cases of infectious disease (see page 25). The labs would be modelled on the US network of infectious-disease labs, such as the naval research unit NAMRU-2 in Jakarta. But they would be funded by the international community
Such a network could vastly speed up and improve the diagnosis of viruses such as H5N1 when outbreaks occur, says Roeder. He points out that misdiagnosis of H5N1 as Newcastle disease in recent outbreaks in Nigeria and India led to long delays in control measures.
Mark Savey, an epidemiologist who heads animal health at France's food-safety agency, also welcomes the proposal, but cautions against the "mirage of technology" in surveillance. "You don't need satellites, PCR and geographic information systems to fight outbreaks," he says. The labs' top priority should be building large teams of local staff, who are familiar with the region and its practices, he argues. "If you do not have that, then surveillance will stay in the Middle Ages."
Savey recalls his trip to Russia last summer as part of a European team investigating outbreaks of avian flu. "You have a paper Michelin map; you have people who speak the language; you put red circles on outbreaks; and you use a pen and paper to compare them with things like the dates of market openings, and with how outbreaks line up with railways." Such local knowledge is crucial to interpreting data, he says. "If you don't know what the Trans-Siberian Express is like, with people cooped up for days, exchanging chickens and eggs at every stop, you would never guess that it was the Trans-Siberian that mainly spread avian flu across Russia."
Roeder agrees that the focus must be local. "No amount of setting international guidelines and publishing global action plans is going to help when you have an organization within the country that doesn't know what to do," he says
ADVANTAGE ONE: DISEASES
THE DANGER OF NEW AND REMERGING DISEASES IS GROWING—THEY QUICKLY SPREAD ACROSS BORDERS MAKING THEM DIFFICULT TO CONTAIN.
US Government Accountability Office, 9-04, “EMERGING INFECTIOUS DISEASES: Review of State and Federal Disease Surveillance Efforts” <http://purl.access.gpo.gov/GPO/LPS55456> [Sigrist]
Infectious diseases account for millions of deaths every year. Although the
great majority of these deaths occur in developing countries, infectious
diseases are not confined by international borders and therefore present a
substantial threat to populations in all parts of the world, including the
United States. In recent years, the threat posed by infectious diseases has
grown. New diseases, unknown in the United States just a decade ago,
such as West Nile virus and severe acute respiratory syndrome (SARS),
have emerged, and known infectious diseases once considered in decline
have reappeared with increased frequency. Furthermore, there is always
the potential for an infectious disease to develop into a widespread
outbreak—which could have significant consequences. The Centers for
Disease Control and Prevention (CDC) estimates that if an influenza
pandemic1 were to occur in the United States, it could cause an estimated
314,000 to 734,000 hospitalizations and 89,000 to 207,000 deaths, with
associated costs ranging from $71 to $167 billion.2 In addition to naturally
occurring infectious disease outbreaks, there is also the threat posed by
the deployment of infectious disease pathogens3 as weapons of war or
instruments of terror.
SPECIFICALLY, SUB SAHARAN AFRICA HAS BECOME AN “IDEAL INCUBATOR” FOR THESE PATHOGENS TO GROW STRONGER.
The Baltimore Sun, 05- 16-05 http://seattletimes.nwsource.com/html/nationworld/2002276179_diseases16.html?syndication=rss
Some of the viruses are notorious, such as Ebola and HIV. Others have less familiar names: Marburg and Lassa fever. But they all have emerged in recent decades from sub-Saharan Africa, perplexing scientists and, in the case of HIV, killing millions. Africa is recognized as an ideal incubator for new pathogens: It has rapidly growing human populations and high biodiversity, along with widespread poverty, poor medical care and, in many countries, armed conflict that forces civilians to flee far from their homes. "For every virus that we know about, there are hundreds that we don't know anything about," said Dr. Dan Bausch, a professor at the Tulane School of Public Health and Tropical Medicine who studies Marburg, Ebola and other emerging diseases in Africa. "Most of them, we probably don't even know that they're out there." Scientists remain especially baffled by Marburg. Since 1967, the Marburg virus and its equally lethal cousin, Ebola, have killed more than 1,600 people. The latest Marburg outbreak has killed at least 277 people in Angola, hundreds of miles from where it last emerged four years ago, in the Democratic Republic of Congo. "To be honest with you, I have no indication what the source is," said Dr. Pierre Formenty, the World Health Organization's senior Marburg expert, speaking from the epicenter of the outbreak, in Uige, Angola. "That was not our first priority. Now we are working on it."
SUBPOINT A: SUPERDISEASES
SEVERAL FACTORS INFLUENCE THE GROWTH AND SPREAD OF PATHOGENS- POPULATION GROWTH, CLIMATE CHANGE, DRUG RESISTANCE, LIVESTOCK HANDLING—ARE ONLY A FEW OF THE THINGS THAT CONTRIBUTE TO MUTATIONS OF DISEASES.
Denise Grady, staff writer, 08/20/02, “Managing Planet Earth” http://query.nytimes.com/gst/fullpage.html?sec=health&res=9C0CE6D6103DF933A1575BC0A9649C8B63
Researchers say West Nile may be just one example of an infectious disease whose incidence and geographic range have expanded because of human activities affecting the mosquitoes, birds, rodents and other animals that help spread the infection. Since the mid-1970's -- a time when it was widely assumed that most infectious diseases had been conquered or at least controlled -- a troubling array of previously unknown diseases has emerged, including Lyme disease, AIDS, mad cow disease, the Ebola virus, Legionnaires' disease and a host of others. In addition, old diseases like yellow fever, malaria and dengue fever have reappeared in their former haunts and spread to new areas. Some microbes, like the ones that cause tuberculosis, malaria and food poisoning, have become dangerously drug resistant. In a 2000 report, the World Health Organization identified a half-dozen factors that could affect the distribution and emergence of infectious diseases. The factors include ecological changes like those from global warming and changes in land use; human factors like population growth, migration, war, sexual behavior, intravenous drug use and overcrowding; international travel and commerce; technological and industrial factors like food processing, livestock handling and organ transplants; microbial changes like the development of antibiotic resistance; and breakdowns in public health measures like sanitation, vaccination and insect control.
THESE MUTATIONS ARE GROWING THREATENING AS DISEASES ARE BECOMING INCREASINGLY DRUG RESISTANCE.
David L Heymann and Guénaël R Rodierthe, WHO's Executive Director for Communicable Diseases, Dec. 01, The Lancet, “Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases” <http://www.3eme-cycle.ch/biologie/JC-Villars06/S1%20Heymann/104_Lancet_Hot%20SpotsInAWiredWorld_2001.pdf>
On another front, resistance to inexpensive and effective
antimicrobial drugs has emerged and spread at an alarming
rate, raising the prospect that many common diseases could
become prohibitively expensive or impossible to treat.27 The
bacterial infections that contribute most to human disease
are also those in which emerging resistance is of most
concern: diarrhoeal diseases such as dysentery, respiratory
tract infections, including pneumococcal pneumonia and
multidrug-resistant tuberculosis, sexually transmitted
infections such as gonorrhoea, and a host of hospitalacquired
infections that are notoriously difficult and
expensive to treat. Among the major infectious diseases, the
development of resistance to drugs commonly used to treat
malaria is of particular concern, as is the emerging resistance
to anti-HIV drugs. Most alarming of all are microbes such as
Staphylococcus aureus and Salmonella typhi that have
accumulated resistance genes to virtually all currently
available drugs and have the potential to cause untreatable
infections, thus raising the spectre of a post-antibiotic era.
Even if the pharmaceutical industry were to step up efforts
to develop new drugs immediately, current trends suggest
that some diseases may have very few and, in some cases, no
effective therapies within the next 10 years.27 Moreover, if
current trends continue, many important medical and
surgical procedures, including cancer chemotherapy, bone
marrow and organ transplantation, and hip and other joint
replacements, could no longer be undertaken out of fear that
the associated compromise of immune function might place
patients at risk of acquiring a difficult to treat and ultimately
fatal infection. Opportunistic infections in AIDS patients
would likewise become an especially difficult challenge.
EVENTUALLY THESE MUTATIONS WILL GET OUT OF CONTROL—CULMINATING IN PLANETARY EXTINCTION.
South China Morning Post 96
((Hong Kong) January 4, 1996 SECTION: Pg. 15 HEADLINE: Leading the way to a cure for AIDS BYLINE: Kavita Daswani meets a scientist working on a super vaccine to fight AIDS and more deadly viruses yet to come, l/n)
Despite the importance of the discovery of the "facilitating" cell, it is not what Dr Ben-Abraham wants to talk about. There is a much more pressing medical crisis at hand - one he believes the world must be alerted to: the possibility of a virus deadlier than HIV. If this makes Dr Ben-Abraham sound like a prophet of doom, then he makes no apology for it. AIDS, the Ebola outbreak which killed more than 100 people in Africa last year, the flu epidemic that has now affected 200,000 in the former Soviet Union - they are all, according to Dr Ben-Abraham, the "tip of the iceberg". Two decades of intensive study and research in the field of virology have convinced him of one thing: in place of natural and man-made disasters or nuclear warfare, humanity could face extinction because of a single virus, deadlier than HIV. "An airborne virus is a lively, complex and dangerous organism," he said. "It can come from a rare animal or from anywhere and can mutate constantly. If there is no cure, it affects one person and then there is a chain reaction and it is unstoppable. It is a tragedy waiting to happen." That may sound like a far-fetched plot for a Hollywood film, but Dr Ben -Abraham said history has already proven his theory. Fifteen years ago, few could have predicted the impact of AIDS on the world. Ebola has had sporadic outbreaks over the past 20 years and the only way the deadly virus - which turns internal organs into liquid - could be contained was because it was killed before it had a chance to spread. Imagine, he says, if it was closer to home: an outbreak of that scale in London, New York or Hong Kong. It could happen anytime in the next 20 years - theoretically, it could happen tomorrow. The shock of the AIDS epidemic has prompted virus experts to admit "that something new is indeed happening and that the threat of a deadly viral outbreak is imminent", said Joshua Lederberg of the Rockefeller University in New York, at a recent conference. He added that the problem was "very serious and is getting worse". Dr Ben-Abraham said: "Nature isn't benign. The survival of the human species is not a preordained evolutionary programme. Abundant sources of genetic variation exist for viruses to learn how to mutate and evade the immune system." He cites the 1968 Hong Kong flu outbreak as an example of how viruses have outsmarted human intelligence. And as new "mega-cities" are being developed in the Third World and rainforests are destroyed, disease-carrying animals and insects are forced into areas of human habitation. "This raises the very real possibility that lethal, mysterious viruses would, for the first time, infect humanity at a large scale and imperil the survival of the human race," he said.
SUB POINT B IS RE-REMERGING DISEASES- THE FLU
[MUTATION OF THE AVIAN FLU IS INEVITABLE—IT IS ONLY A MATTER OF TIME UNTIL IT IS AIRBORNE.
Satish Chandra, Deputy National Security Advisor of India – Center for Strategic Decision Research, 2004
[Global Security: A broader Concept for the 21st Century, 5/7, http://www.csdr.org/2004book /chandra.htm]
If the possibility of the collapse of the thermohaline circulation system is alarming, the possibility of a human-to-human transmittable bird flu pandemic is a nightmare. What makes it so frightening is the fact that it could happen at any time and that we are ill prepared to face it. At current mortality rates, it could result in the sudden death of 15 to 20 percent of mankind. The most severe health crisis in recent years in terms of numbers of deaths was the 1918–1919 influenza epidemic, which in the space of one year caused an estimated 40 million deaths worldwide. Begun in Kansas in March 1918, the epidemic spread to Europe and then to India, Australia, and New Zealand. The virulence and mortality rate of the first wave of the disease, in the spring of 1918, was only slightly above normal levels but the second wave, which began in the fall of 1918, was extraordinarily deadly, with mortality rates of 5 to 20 percent above normal levels. It is believed that the fall strain of the virus came about through genetic mutation and that the genetic structure of the virus was a form of a swine and avian influenza strain. Since 1918, the world has seen several influenza outbreaks, most notably the 1957 Asian flu outbreak and the 1968 Hong Kong flu outbreak, each of which killed a million people. While WHO now has an Influenza Surveillance Program in place as well as an Influenza Pandemic Preparedness Plan, we still need to examine the possibility of the highly pathogenic H5N1 bird flu becoming transmittable from human to human, the outcome of such a situation, and what must be done to address the possibility. Since the end of 2003, outbreaks of the highly pathogenic H5N1 strain of avian influenza, or bird flu, have occurred in eight Asian countries, resulting in the loss of 100 million poultry birds. The implications for human health are worrisome because of the extreme pathogenic nature of this virus—it has the capability to infect humans and cause severe illness, with mortality rates of 60 to 70 percent. It has already infected humans three times in the recent past: In 1997 and 2003 in Hong Kong and in 2004 in Vietnam and Thailand. So far the disease has been transmitted only to humans who came in contact with dead or diseased poultry—it has not yet mutated to being capable of human-to-human transmission. The Likelihood of a Pandemic Since the H5N1 strain has not been eliminated from its avian hosts, it is obviously endemic. The risk, therefore, that the virus could take on a new form that would make it capable of human-to- human transmission is considerable, especially because mass vaccinations of chickens, aimed at mitigating the disaster facing poultry farmers, has allowed the virus to continue to circulate among the vaccinated birds. It can thus linger indefinitely in poultry, making the gene mutation required to make it transmittable from human to human an even greater possibility. It could be said that there are three prerequisites for the start of a pandemic: 1) a new virus must emerge against which the general population has little or no immunity; 2) the new virus must be able to replicate in humans and cause disease; and 3) the new virus must be efficiently transmitted from one human to another. Dr. Anarji Asamoa Baah, Assistant Director General, Communicable Diseases, WHO, asserts that, regarding H5N1, the first two prerequisites have already been met, and it is known that the virus can become more transmittable via two mechanisms, “adaptive mutation” and “genetic re-assortment.” Dr. Baah has further contended that re-assortment of H5N1 with a human influenza virus can take place in humans without prior adaptation in other species such as swine. It is clear, therefore, that 1) the H5N1 virus will continue to circulate for a very long time in poultry birds; 2) the threat to public health will be there as long as the virus continues to circulate in poultry birds; 3) should the virus become transmittable from human to human, the consequences for human health worldwide, in the words of Dr. Baah, “could be devastating;” and 4) the world needs to be prepared to respond to the next influenza outbreak. During an Influenza Pandemic Preparedness meeting in Geneva in March 2004, the head of the World Health Organization warned, “We know another pandemic is inevitable. It is coming…we also know that we are unlikely to have enough drugs, vaccines, healthcare workers, and hospital capacity to cope in an ideal way.” On the basis of an epidemiological model project, WHO scientists predict that an influenza pandemic will result in 57 million to 132 million outpatient hospital visits, 1 million to 2.3 million admissions, and between 280,000 and 650,000 deaths in less than two years. The impact on poor nations would be much greater. But I submit that these projections are gross underestimates given the fact that the 1918–1919 influenza epidemic, with mortality rates of a maximum of 20 percent above normal level, caused as many as 40 million deaths. With mortality rates in excess of 60 percent, the H5N1 virus is bound to be much more deadly, particularly because in today’s world of air connectivity, the spread of H5N1 would be much more rapid than that of the 1918 influenza epidemic. Indeed, the death toll could run into hundreds of millions.
AVIAN BIRD FLU WILL KILL BILLIONS.
Satish Chandra, Center for Strategic Decision Research, 2004
[Global Security: A broader Concept for the 21st Century, May 7th http://www.csdr.org/2004book /chandra.htm]
This scenario, as frightening as it is, pales in comparison with what could overtake us by 2007 if the highly pathogenic form of bird flu “H5N1” becomes transmittable human to human; all it would take for this to happen is a simple gene shift in the bird flu virus, which could happen any day. In a globalized world linked by rapid air travel, the disease would spread like a raging forest fire. If it did, it would overwhelm our public health system, cripple our economies, and wipe out a billion people within the space of a few months—a 60 percent mortality rate is estimated.
SURVEILLANCE IS CRITICAL TO MONITOR ANIMAL TRANSFERRED PATHOGENS.
Paul Rincon, BBC News science reporter, 2/20/06, ("'Faster emergence' for diseases", http://news.bbc.co.uk/2/hi/science/nature/4732924.stm)
New infectious diseases are now emerging at an exceptional rate, scientists have told a leading conference in St Louis, US. Humans are accumulating new pathogens at a rate of one per year, they said.
This meant that agencies and governments would have to work harder than ever before to keep on top of the threat, one expert told the BBC. Most of these new infectious diseases, such as avian influenza and HIV/Aids, are coming from other animals. "This accumulation of new pathogens has been going on for millennia - this is how we acquired TB, malaria, smallpox," said Professor Mark Woolhouse, an epidemiologist at the University Of Edinburgh, UK. "But at the moment, this accumulation does seem to be happening very fast. "So it seems there is something special about modern times - these are good times for pathogens to be invading the human population." Professor Woolhouse has catalogued more than 1,400 different agents of disease in humans; and every year, scientists are discovering one or two new ones.
Some may have been around for a long time and have only just come to light. Others that have emerged recently are entirely new, such as HIV; the virus that causes Sars, and the agent of vCJD. The difference today, say researchers, is the way humans are interacting with other animals in their environment. Changes in land use through, for example, deforestation can bring humans into contact with new pathogens; and, likewise, agricultural changes, such as the use of exotic livestock. Other important drivers include global travel, global trade and hospitalisation. The fast rate at which pathogens are appearing means public health experts will need to work harder than ever to control the spread of emerging disease threats. "The sort of image I want to get away from is the famous statement from the 1960s when the US Surgeon General said, 'diseases were beat'," Professor Woolhouse told the BBC News website. "Pathogens are evolving ways to combat our control methods. The picture is changing and looks as if it will continue to. We're going to have to run as fast as we can to stay in the same place." He added: "We need surveillance. Surveillance in most parts of the world for infectious disease is really quite poor - particularly surveillance for infectious diseases in animals such as vermin like rats." Experts were speaking on the subject at the American Association for the Advancement of Science (AAAS) annual meeting in the Missouri city of St Louis.
ADVANTAGE TWO: BIOTERRORISM
RISK OF A BIOTERROR ATTACK IS HIGH WITH THE WIDESPREAD OFMATERIALS, INFORMATION, AND RECRUITMENT IN ABUNDANCE.
Bruce jones – biosecurity nonststate actors & the need for global cooperation 10/1/06
http://www.blackwell-synergy.com/action/showFullText?submitFullText=Full+Text+HTML&doi=10.1111%2Fj.1747-7093.2006.00016.x&cookieSet=1
Unfortunately, both the risk of a bioterror attack and the potential destruction such an attack could cause are significant—and rising.
In assessing the risk of a given type of attack, there are three ingredients to measure: the availability of the relevant materials (from small arms to "loose nukes"); the availability of know-how to overcome the obstacles to using those materials to effect an attack; and the existence of actors with the motive to use them. In the case of bioterrorism, all three ingredients are very much present.
First, there is no shortage of supply. The biological materials for potentially deadly attacks are tremendously widespread. By one estimate, there are more than 10,000 facilities worldwide that legally and legitimately possess materials that, if weaponized, could cause enormous loss of life, morbidity, and erosion of health. Many of these facilities are agricultural and commercial, not engaged in high-tech bioengineering or advanced processes that could reasonably be expected to come with detailed tracking of materials and effective security arrangements.
Second, there is no shortage of know-how. One of the great advantages of the biological and health industry is its widening base of scientists worldwide—an advantage that has an obvious downside, in the existence [in] of a large number of individuals whose knowledge can be tapped for nefarious purposes. Moreover, the technological know-how and materials for weaponizing several biological agents is increasingly available, even to individuals. In preparing background materials for the High-Level Panel, we were warned by some of the world's leading scientists that it would be only a matter of years before the tools required for weaponization were available through the Web. As we completed our work, some of these same scientists alerted us to the fact that they had been mistaken: materials are already available on the Web, often for as little as $50,000.
Third, there is no shortage of groups with motive—at least, as far as we know. Certainly, senior al-Qaeda officials have stated publicly and in captured correspondence between themselves their interest in obtaining nuclear, biological, and chemical materials for use in large-scale terrorist attacks. But the history of modern terrorism suggests that we should be every bit as concerned by groups we don't yet know about. Given the widespread availability and relatively easy accessibility of materials, and the accessibility of equipment and know-how to weaponize them, even fairly unsophisticated groups pose a threat. Indeed, as the science and the technology develops, we face the prospect that eventually small groups and even individuals will possess the technological ability to threaten even powerful states.
A BIOTERRORIST ATTACK WOULD RESULT IN EXTINCTION AS THE ATTACK CAN’T BE CONTAINED AND WILL SPREAD QUICKLY.
Richard Ochs, president of CWWG (Chemical Weapons Working Group), 2002 "biological weapons must be abolished immediately" <http://www.freefromterror.net/other_articles/abolish.html>
Of all the weapons of mass destruction, the genetically engineered biological weapons, many without a known cure or vaccine, are an extreme danger to the continued survival of life on earth. Any perceived military value or deterrence pales in comparison to the great risk these weapons pose just sitting in vials in laboratories.
While a "nuclear winter," resulting from a massive exchange of nuclear weapons, could also kill off most of life on earth and severely compromise the health of future generations, they are easier to control. Biological weapons, on the other hand, can get out of control very easily, as the recent anthrax attacks has demonstrated. There is no way to guarantee the security of these doomsday weapons because very tiny amounts can be stolen or accidentally released and then grow or be grown to horrendous proportions. The Black Death of the Middle Ages would be small in comparison to the potential damage bioweapons could cause.
Abolition of chemical weapons is less of a priority because, while they can also kill millions of people outright, their persistence in the environment would be less than nuclear or biological agents or more localized. Hence, chemical weapons would have a lesser effect on future generations of innocent people and the natural environment. Like the Holocaust, once a localized chemical extermination is over, it is over. With nuclear and biological weapons, the killing will probably never end. Radioactive elements last tens of thousands of years and will keep causing cancers virtually forever.
Potentially worse than that, bio-engineered agents by the hundreds with no known cure could wreck even greater calamity on the human race than could persistent radiation. AIDS and ebola viruses are just a small example of recently emerging plagues with no known cure or vaccine. Can we imagine hundreds of such plagues? HUMAN EXTINCTION IS NOW POSSIBLE.
LUCKILY, DISEASE SURVEILLANCE IS AN OPPORTUNITY TO TAP INTO THE PUBLIC HEALTH SYSTEM AS AN INTELLIGENCE RESOURCE IN ORDER TO PREVENT AND RAPIDLY RESPOND TO A POTENTIAL ATTACK.
PRNewswire, 8-4,-2005, Nexus (C-5)
"Better medical surveillance tools and stronger links between law enforcement and national health authorities are needed to help protect the world against attacks from terrorists using chemical or biological weapons," emergency preparedness specialist Michael J. Hopmeier told a recent conference on integrating intelligence, policing and health, co-hosted by the Public Health Agency of Canada.
"The public health system presents an enormous untapped resource for intelligence gathering and the protection of national security," said Hopmeier, President of Unconventional Concepts Inc., a Mary Esther, Florida- based engineering and scientific consulting firm specializing in crisis management and integrated federal/civilian disaster response.
"Beyond the roles in prevention and protection played by the public health sector, and their obvious implications for national security, there is also an enormous infrastructure for early warning detection of terrorist threats," Hopmeier said. "For that reason, public health agencies can contribute to both intelligence collection and national security
THUS WE OFFER THE FOLLOWING PLAN:
The United States Federal Government should substantially increase its public health assistance to Sub-Saharan Africa by fully funding the creation of disease surveillance laboratories in Sub-Saharan Africa under the authority of the Department of Defense.
OBSERVATION TWO: SOLVENCY
EMPIRICALLY, THE DOD HAS BEEN EFFECTIVE AT PREVENTING AND TREATING DISEASE OUTBREAKS IN AFRICA.
Patrick W. Kelley, M.D., Dr. P.H., Colonel and Director, Division of Preventive Medicine Walter Reed Army Institute of Research, Institute of Medicine (Authoring organization), 2001, “Emerging Infectious Diseases from the Global to the Local Perspective”, p. 57, http://books.nap.edu/openbook.php?record_id=10084
An example of recent DOD involvement in Africa was the outbreak of Rift Valley fever in 1997–1998 in East Africa. Approximately 80,000 people ultimately contracted Rift Valley fever, resulting in hundreds of deaths. In addition to the direct toll on the human population, there was a tremendous toll on the animal population in this pastoral economy. Using its laboratory in Kenya, DOD was able to quickly assist with the initial epidemiological and entomological investigations. At the time that the outbreak surfaced Kenya had no laboratory capacity for the diagnosis of Rift Valley fever. Specimens had to be sent to either South Africa or CDC to make the diagnosis. Using resources at its laboratory in Cairo, DOD was able to quickly transfer technology for rapid diagnosis to Kenya so that the outbreak could be defined rapidly and locally. Experts in remote sensing also collected data to establish indicators that are evident at least 3 or 4 months before outbreaks. In the future this will enable the government to initiate immunizations for animals and thus prevent the amplification of the virus and its transmission to humans. DOD also provided access to the Rift Valley fever vaccine for at-risk laboratory workers in Kenya.
DOD LABORATORIES ARE CAPABLE OF STREAMLINING THE AFRICAN SURVEILLANCE SYSTEM, AND OFFER THE BEST TECHNOLOGY AND PERSONNEL TRAINING.
Patrick W. Kelley, M.D., Dr. P.H., Colonel and Director, Division of Preventive Medicine Walter Reed Army Institute of Research, Institute of Medicine (Authoring organization), 2001, “Emerging Infectious Diseases from the Global to the Local Perspective”, p. 56, http://books.nap.edu/openbook.php?record_id=10084
A major asset is the DOD network of overseas laboratories in Egypt, Kenya, Thailand, Indonesia, and Peru. These are medical research and development laboratories that in some cases were established more than 50 years ago and that exist primarily for the purpose of product development. For example, the key studies conducted for the licensure of the hepatitis A and the Japanese encephalitis vaccines were done at these laboratories.
These laboratories have, in some instances, a biosafety level 3 capability. The laboratory in Cairo, Egypt, can if necessary, adapt to a biosafety level 4 capability. Although located in 5 countries, these laboratories have active research programs in about 31 countries; they have established extensive networks in their regions and have formal relationships with many ministries of health and the WHO.
The laboratories have tremendous depth. In almost every case they have expertise in virology, bacteriology, parasitology, other aspects of microbiology, veterinary medicine, and epidemiology. Although their primary purpose was to support product development, increasingly they are becoming involved with surveillance. In all, about 700 people work at these laboratories and are backed up by more than 800 more DOD scientists working on issues related to emerging infections.
The laboratories have additional assets: they are networked with state-of-the-art communications technologies and possess cutting-edge field diagnostic reagents that are field oriented, rapid, and invaluable in the response to emerging infectious diseases. In addition, the laboratories have access to special drugs and vaccines that might be of critical importance in regions with outbreaks of unusual pathogens.
FINALLY, THE US HAS TO ACT—ONLY THE US CAN ENSURE GLOBAL DISEASE COOPERATION.
David P. Fidler, professor of law, University of Indiana, 3/6/05, “Germs, Norms, and Power: Global Health’s Political Revolution”, http://www2-test.warwick.ac.uk/fac/soc/law/elj/lgd/2004_l/fidler/
Dramatic change marks the history of health as an issue in international relations. Health’s emergence as a foreign policy concern in the mid-19th century, when European nations began to confront cooperatively the cholera menace, represents one such dramatic transition in how health was conceptualised and approached internationally. Subsequent treaties and international health organisations also transformed health as a foreign policy concern. Technological developments, especially antibiotics and vaccines, also produced change for public health globally.
These examples of changes in international health reveal and obscure. They reveal that health has long been a foreign policy issue. Given this history, ‘health as foreign policy’ is not a novel idea. The examples obscure that health has historically been relegated to the foreign policy fringe of technical assistance and humanitarianism. The lack of interest in health by those studying foreign policy and international relations compounded the neglect (Lee, K and Zwi, A, 2003, p 13; Kickbusch, I, 2003, p 192). Given this situation, ‘health as foreign policy’ was not an important diplomatic activity.
Dramatic change has, however, again visited health as an issue in international relations. In the past decade, health emerged from obscurity and neglect to affect many foreign and international policy agendas. Health now features prominently in debates concerning national and homeland security, international trade, economic development, globalisation, human rights, and global governance. The attention health has received in the past ten years in national and international politics is unprecedented. Kickbusch (2003, pp 192-93) captured this change:
The protection of health is no longer seen as primarily a humanitarian and technical issue relegated to a specialised UN agency, but more fully considered in relation to the economic, political, and security consequences for the complex post-Cold War system of interdependence. This has led to new policy and funding initiatives at many levels of governance and a new political space within which global health action is conducted.
Health as a global issue has undergone a political revolution in the last decade. Health’s emergence into the ‘high politics’ of international relations is a complicated and controversial development. Global health’s political revolution means that traditional approaches to, and attitudes about, public health have been ripped from their moorings and set afloat on a volatile sea. This article examines global health’s political revolution by analyzing its components and how they relate to each other in an attempt to understand the meaning of this revolution for global health’s future.
Revolutions constitute radical changes within existing political systems, and they typically involve three elements: (1) a crisis with the status quo; (2) a challenge from normative ideas different from those operative in the existing system; and (3) the application of material power to install the new ideas as the basis for future action. The article explores each of these elements in connection with global health’s transformation as an issue in international relations.
The crisis comes from threats posed by infectious diseases (germs). The mounting microbial menace has stimulated ferment among policy responses that seek to supercede existing strategies and alter how state and non-state actors address pathogenic threats (norms). The competing ideas require material resources and capabilities to contain and mitigate the microbial challenge to health (power).
How germs, norms, and power converge shapes the nature of global health’s political revolution. I argue that the political revolution remains enigmatic, and the enigma raises questions about the revolution’s impact and sustainability. Global health’s political revolution serves as a window on the future of not only the protection of health but also 21st century world politics.